differential diagnosis

Shin Splints

Definition

 

Medial Tibial Stress Syndrome

- pain along the tibial origin of tibialis posterior or soleus

 

Clinical

 

Pain anterior aspect of shin

- running

- soccer

- basketball

 

DDx 

 

Compartment Syndrome

Stress fracture of tibia

 

Mechanism

 

Usually 2° to changes in activity

- increase in mileage

Sportsman's Hernia

Definition

 

Groin pain in athletes

- secondary to tear in external oblique fascia

 

Epidemiology

 

Sports with aggressive adduction

- hockey / soccer

 

Pathology

 

Tears in external oblique fascia

- tend to be central

- around spermatic cord and ilioinguinal nerve

- pain may be from nerve entrapment

 

DDx

 

Adductor Longus Tear

Chondrocalcinosis

Definition

 

The deposition of calcium in joints

- often in degenerative cartilage

- many different causes

 

Crystals can be salts of

- Calcium pyrophosphate dihydrate (CPPD)

- Dicalcium phosphate hydrate

- Calcium hydroxyapatite

- Calcium oxalate

 

Differential Diagnosis

 

WHIP A DOG 

 

Wilson's

Haemochromatosis, hyperparathyroidism

Painful TKR

Differential Diagnosis of the Painful TKA 

 

Surgical Diagnosis  

 

1.  Prosthetic loosening and failure 

2.  Infection 

3.  Patellofemoral tracking problems  

4.  Instability 

5.  Recurrent intra-articular soft-tissue impingement / Component overhang  

 

Nonsurgical Diagnoses  

 

1.  Referred pain - Hip / Back  

Approach to Primary Bone Tumour

Steps

 

1. Establish a differential

2. Stage locally and systemically

3. Biopsy

4. Definitive Treatment

 

1. Establish a Differential

 

Lytic Lesion Distal Femur0002

 

Lesion detected on X-ray

 

Questions

- what do you think it is?

Loose Bodies

Knee Loose Bodies Fragments

 

Source

 

OCD

OA - Osteophytes

Meniscus

 

Symptoms

 

Pain

Locking

Clicking

Can cause chondral damage

 

Xray

 

OA Loose Bodies

Trochanteric Bursitis & Gluteus Medius

Trochanteric Bursitis

 

Mechanism

 

Repetitive friction of iliotibial tract over GT

 

Aetiology

 

Overuse in athletes

Common post THR

 

May be associated with gluteus medius tears

 

Symptoms

 

Pain over upper lateral thigh with activity

- often related to hip flexion

 

Examination

 

Transient Osteoporosis Hip

Definition

 

Self limiting syndrome of unknown aetiology

- hip pain associated with osteoporosis of proximal femur 

 

DDx

 

AVN

- AVN of the hip in pregnancy is rare but possible

- TOH tends to be diffuse on MRI, while AVN is localised

- extends to neck and metaphysis

- transient osteoporosis has normal bone scan

 

Incidence

 

Rare

- M: F 3:1

Claw Toe

Definition

 

Hyperextension of MTPJ and PIPJ / DIPJ flexion

- usually all toes affected 

 

Claw Toes

 

DDx

 

1.  Complex hammer

- hammer toe with MTPJ extension

- hammer usually affects second toe

 

2.  Curly toe

DDx DIPJ OA

DDx

 

OA

Psoriasis

CREST (scleroderma)

 

RA (rare form)

Other seronegative arthropathies

Hyperparathyroidism

Reactive arthropathy

Gout

 

 

 

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